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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

after dealing with "prostatic" symptoms for 6 months now, the urologist recommended a biopsy. On Feb. 7,  12 biopsies were performed. All Bxs came back negative and the report says "mild atrophy and mild chronic inflammation". I'm totally lost here. There were some small calcifications shown in the TURS, dr. said they were normal and are not suppose to be the cause of infl. I've read a report from dr. Shoskes in which they have tried an antibiotic protocol for long time prostatisi/ccps sufferers. I've also read reports on the connection between adrenal functions and chronic inflammation. At this point, my symptoms seem to be improving although I still have mild abdominal pain. One of the best places to get good information related to BPH is the John Hopkins papers. I also found valuable info. on the cpps forum, although the administrator of the forum seems pretty dogmatic about the causes of CPPS, they just think that prostate/urinary/pelvic pain is caused by neuromuscular issues. The more I read about all this I realize that most of the information is geared to sell you "the magic" treatment. My game plan for now is to keep using Uroxathral and Avodart. By the way the size of my prostate is 24.60ml. Other than that, I'll try to  stay away as much as possible from urologists!

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Why are you lost, Mauricio? What is the connection between the biopsy findings and the symptoms?
well i though there was a connection between penile pain, frequent urination and inflammation, but i'm not sure now after reading the neuro muscular theories

There can be a correlation between inflammation and pain. For example, a urine infection can result in both inflammatory reaction and symptoms, including pain.


A prostate biopsy is not generally used to diagnosed and/or guide the treatment of the symptoms associated with chronic prostatitis/chronic pelvic pain syndrome. A prostate biopsy is generrally used to diagnose and/or guide the treatment of prostate cancer, which is in almost all cases a completely asymptomatic illness at the time of diagnosis.


One should also keep in mind that inflammation is a very, very common finding in prostates, including in prostates of men who have no symptoms at all, e.g. the prostate of men who have them removed for prostate cancer. So the finding of inflammation and/or bacteria and/or viruses in prostate tissue is absolutely not specific for symptoms or for an effective treatment of symptoms.


Leaving theories and academics aside, at issue for any patient suffering from symptoms he wants to get rid of is the answer to this questions: Which treatment will help me to feel better? And the second question: Is there a test that can help me to better understand the possible causes of my symptoms and therefore to guide the their treatment?


It's not clear to me where "neuro muscular theories" fit into the context of either findings of [nonspecific] inflammation and/or the findings of  a prostate  biopsy. Again: Will these mechanistic theories lead to effective relief from symptoms? If so, where are the supporting data? At the bedside, this is all that really matters.

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